Effect of mobile text messages on antiretroviral medication adherence and patient retention in early HIV care: an open-label, randomized, single center study in south Florida.

BACKGROUND: People with HIV (PHIV) with limited access to health services often experience suboptimal antiretroviral therapy (ART) adherence. We investigated whether a daily text messaging intervention improves ART adherence and retention in early HIV care in PHIV in a south Florida hospital-based clinic. METHODS: ART-naïve PHIV receiving care through the clinic's Ryan White HIV/AIDS Program were enrolled and randomly assigned to the intervention or control groups with a 1:1 ratio. The intervention group received a 1-way text message daily and the control group received standard care without receiving text message reminders for 6 months. HIV RNA and CD4 cell count were measured at baseline and post-intervention. Adherence to ART was defined as a visual analog scale of ≥ 90%. Retention in care was defined as continued engagement at study end. RESULTS: 94 ART-naïve patients were randomized and 83 (85.6%) completed the study, of which 44 were in the intervention group and 39 were in the control group. At the end of the 6-month study period, adherence to ART was 84.4% in the intervention group versus 73.5% in the control group (OR, 1.9; 95% CI 0.7-5.0; p = 0.194). Retention in care significantly improved in the intervention group compared to the control group with the odds of retention increasing by 20% (OR, 1.2; 95% CI 1.1-1.5; p = 0.006). Undetectable HIV RNA (< 50 copies/mL) was 86.7% in the intervention group versus 73.5% in the control group (OR, 2.3; 95% CI 0.8-6.9; p = 0.112). A significant increase in CD4 cell count and a decrease in HIV RNA were found at study end, with no differences between the two groups. CONCLUSIONS: In this pilot study, a one-way daily text messaging intervention did not improve ART adherence over a 6-month study period, but significantly enhanced patient retention in early HIV care. Implementation of interventions to improve adherence in this population is required.

'Fit-for-purpose?' - challenges and opportunities for applications of blockchain technology in the future of healthcare.

Blockchain is a shared distributed digital ledger technology that can better facilitate data management, provenance and security, and has the potential to transform healthcare. Importantly, blockchain represents a data architecture, whose application goes far beyond Bitcoin - the cryptocurrency that relies on blockchain and has popularized the technology. In the health sector, blockchain is being aggressively explored by various stakeholders to optimize business processes, lower costs, improve patient outcomes, enhance compliance, and enable better use of healthcare-related data. However, critical in assessing whether blockchain can fulfill the hype of a technology characterized as 'revolutionary' and 'disruptive', is the need to ensure that blockchain design elements consider actual healthcare needs from the diverse perspectives of consumers, patients, providers, and regulators. In addition, answering the real needs of healthcare stakeholders, blockchain approaches must also be responsive to the unique challenges faced in healthcare compared to other sectors of the economy. In this sense, ensuring that a health blockchain is 'fit-for-purpose' is pivotal. This concept forms the basis for this article, where we share views from a multidisciplinary group of practitioners at the forefront of blockchain conceptualization, development, and deployment.

Geospatial blockchain: promises, challenges, and scenarios in health and healthcare.

A PubMed query run in June 2018 using the keyword 'blockchain' retrieved 40 indexed papers, a reflection of the growing interest in blockchain among the medical and healthcare research and practice communities. Blockchain's foundations of decentralisation, cryptographic security and immutability make it a strong contender in reshaping the healthcare landscape worldwide. Blockchain solutions are currently being explored for: (1) securing patient and provider identities; (2) managing pharmaceutical and medical device supply chains; (3) clinical research and data monetisation; (4) medical fraud detection; (5) public health surveillance; (6) enabling truly public and open geo-tagged data; (7) powering many Internet of Things-connected autonomous devices, wearables, drones and vehicles, via the distributed peer-to-peer apps they run, to deliver the full vision of smart healthy cities and regions; and (8) blockchain-enabled augmented reality in crisis mapping and recovery scenarios, including mechanisms for validating, crediting and rewarding crowdsourced geo-tagged data, among other emerging use cases. Geospatially-enabled blockchain solutions exist today that use a crypto-spatial coordinate system to add an immutable spatial context that regular blockchains lack. These geospatial blockchains do not just record an entry's specific time, but also require and validate its associated proof of location, allowing accurate spatiotemporal mapping of physical world events. Blockchain and distributed ledger technology face similar challenges as any other technology threatening to disintermediate legacy processes and commercial interests, namely the challenges of blockchain interoperability, security and privacy, as well as the need to find suitable and sustainable business models of implementation. Nevertheless, we expect blockchain technologies to get increasingly powerful and robust, as they become coupled with artificial intelligence (AI) in various real-word healthcare solutions involving AI-mediated data exchange on blockchains.

Patient Participation at Health Care Conferences: Engaged Patients Increase Information Flow, Expand Propagation, and Deepen Engagement in the Conversation of Tweets Compared to Physicians or Researchers.

BACKGROUND: Health care conferences present a unique opportunity to network, spark innovation, and disseminate novel information to a large audience, but the dissemination of information typically stays within very specific networks. Social network analysis can be adopted to understand the flow of information between virtual social communities and the role of patients within the network. OBJECTIVE: The purpose of this study is to examine the impact engaged patients bring to health care conference social media information flow and how they expand dissemination and distribution of tweets compared to other health care conference stakeholders such as physicians and researchers. METHODS: From January 2014 through December 2016, 7,644,549 tweets were analyzed from 1672 health care conferences with at least 1000 tweets who had registered in Symplur's Health Care Hashtag Project from 2014 to 2016. The tweet content was analyzed to create a list of the top 100 influencers by mention from each conference, who were then subsequently categorized by stakeholder group. Multivariate linear regression models were created using stepwise function building to identify factors explaining variability as predictor variables for the model in which conference tweets were taken as the dependent variable. RESULTS: Inclusion of engaged patients in health care conference social media was low compared to that of physicians and has not significantly changed over the last 3 years. When engaged patient voices are included in health care conferences, they greatly increase information flow as measured by total tweet volume (beta=301.6) compared to physicians (beta=137.3, P<.001), expand propagation of information tweeted during a conference as measured by social media impressions created (beta=1,700,000) compared to physicians (beta=270,000, P<.001), and deepen engagement in the tweet conversation as measured by replies to their tweets (beta=24.4) compared to physicians (beta=5.5, P<.001). Social network analysis of hubs and authorities revealed that patients had statistically significant higher hub scores (mean 8.26×10-4, SD 2.96×10-4) compared to other stakeholder groups' Twitter accounts (mean 7.19×10-4, SD 3.81×10-4; t273.84=4.302, P<.001). CONCLUSIONS: Although engaged patients are powerful accelerators of information flow, expanders of tweet propagation, and greatly deepen engagement in conversation of tweets on social media of health care conferences compared to physicians, they represent only 1.4% of the stakeholder mix of the top 100 influencers in the conversation. Health care conferences that fail to engage patients in their proceedings may risk limiting their engagement with the public, disseminating scientific information to a narrow community and slowing flow of information across social media channels.

Cognitive and Performance Enhancing Medication Use to Improve Performance in Poker.

Use of neuroenhancers has been studied in groups ranging from students to surgeons; however, use of cognitive and performance enhancing medications (CPEMs) to improve performance in poker has remained largely overlooked. To assess the use of CPEMs to improve poker performance, a survey of poker players was conducted. Participants were recruited via Internet poker forums; 198 completed the online survey. Approximately 28 % of respondents used prescription CPEMs, with the most commonly used including: amphetamine/dextroamphetamine (62 %), benzodiazepines (20 %), and methylphenidate (20 %). CPEMs were used in poker to focus (73 %), calm nerves (11 %), and stay awake (11 %). Caffeine (71 %), as well as conventionally counter-intuitive substances like marijuana (35 %) and alcohol (30 %) were also reported to enhance poker performance. Non-users of CPEMs were dissuaded from use due to not knowing where to get them (29 %), apprehension about trying them (26 %), and legal or ethical concerns (16 %). Respondents most frequently acquired CPEMs via friends/fellow poker players (52 %), or prescription from physician (38 %). Additionally, greater use of CPEMs was associated with living outside the United States (p = 0.042), prior use of prescription medications for improving non-poker related performance (p < 0.001), and amateur and semi-professional player status (p = 0.035). Unmonitored use of pharmacologically active agents and their methods of acquisition highlight safety concerns in this cohort of poker players, especially among non-professional players. The current state of guidance from national organizations on CPEM use in healthy individuals could impact prescribing patterns.

Social media use and educational preferences among first-year pharmacy students.

BACKGROUND: Social media may offer a means to engage students, facilitate collaborative learning, and tailor educational delivery for diverse learning styles. PURPOSE: The purpose of this study is to characterize social media awareness among pharmacy students and determine perceptions toward integrating these tools in education. METHODS: A 23-item survey was administered to 1st-year students at a multicampus college of pharmacy. RESULTS: Students (95% response rate; N = 196) most commonly used wikis (97%), social networking (91%), and videosharing (84%). Tools reported as never used or unknown included social bookmarking (89%), collaborative writing (84%), and RSS readers (73%). Respondents indicated that educational integration of social media would impact their ability to learn in a positive/very positive manner (75%) and make them feel connected/very connected (68%). CONCLUSIONS: Selectively targeting social media for educational integration and instructing pharmacy students how to employ a subset of these tools may be useful in engaging them and encouraging lifelong learning.

Characterization of doctor of pharmacy/health informatics dual degrees in the United States.

INTRODUCTION: Health care is trending towards an increasing reliance on data management, technology, analytics, and automation which is also reflected in pharmacy education. This study aimed to identify and characterize doctor of pharmacy (PharmD)/master of science in health informatics (MSHI) dual-degree offerings at pharmacy institutions within the United States (US). METHODS: A list of PharmD/MSHI programs was obtained from the American Association of Colleges of Pharmacy and the Pharmacy College Application Service. Furthermore, websites of the 143 accredited schools and colleges of pharmacy in the US were inspected to identify additional PharmD/MSHI dual degrees not identified with the previous sources and to verify that the dual degree was being actively offered at each institution. A 26-item questionnaire focusing on program structure, admissions, and output was developed and administered to program representatives via phone interview. Descriptive statistics were calculated. RESULTS: Thirteen schools offering a PharmD/MSHI dual degree were identified, of which 10 participated (response rate = 77%). All programs were created within the last 10 years. Programs were similar in terms of admission requirements such as grade point average thresholds and standardized testing. Variances existed in program structure and output, such as accreditation status and number of enrollees/graduates. CONCLUSIONS: Although health informatics has become more prominent in health care, health informatics education is not yet as pervasive in the pharmacy field. The information collected may be useful for schools considering implementing or modifying their own dual degree program or for students who are interested in health informatics-specialized educational opportunities.

Community pharmacists' use of language-access services in the United States.

OBJECTIVE: To examine community pharmacists' use of language-access services (LASs) in the United States. DESIGN: Cross-sectional study. SETTING: United States from January to February 2009. PARTICIPANTS: 1,000 pharmacists (500 community chain and 500 community independent pharmacists). INTERVENTION: Mailed survey. MAIN OUTCOMES MEASURE: Use, availability, and characterization of written translation and verbal interpretation LASs, along with perceived barriers for LASs. RESULTS: 296 surveys were completed, yielding an adjusted response rate of 30.0%. Computer software was used more often for translation LASs (57.4%) compared with pharmacists using on-site personnel (38.4%). Almost one-half of all pharmacies (49.8%) that possessed LAS capacity failed to notify patients of their availability. Many respondents indicated that they never used translation (40.9%) or interpretation (39.8%) in their pharmacies. The most commonly cited barrier for use of LASs by community pharmacists was potential inaccuracies in translation/interpretation (52.1%). Lack of time (25.1%) was frequently cited for failing to use LASs. CONCLUSION: Community pharmacists are not consistently or optimally using LASs in daily practice. Failure to use LASs can result in poorer outcomes for patients with limited English proficiency. Developing means to navigate work station-related barriers to LASs may yield improved patient care. Incorporation of professional continuing educational programs, automated LAS kiosks, natural language processing, and social media solutions merit exploration in addressing these challenges.

A systematic evaluation of paediatric medicines information content in clinical decision support tools on smartphones and mobile devices.

BACKGROUND: Medication information is often poorly delineated for paediatric patients, resulting in high off-label and non-licensed use of drugs in this population. Access to accurate medicines information in this population becomes a necessity in order to avoid medication errors. Clinical decision support tools (CDSTs), which are increasingly available on mobile devices (e.g. smartphones), can provide healthcare providers with convenient access to paediatric medicines information at point of care. However, to date no systematic evaluation of the content in these CDSTs has been conducted. OBJECTIVES: To evaluate paediatric medicines information in CDSTs for smartphones and other mobile devices. METHOD: Evaluation of CDSTs according to scope and completeness was accomplished via weighted categories of 108 questions distributed evenly across three age groups: infants, children and adolescents. RESULTS: Three paediatric-specific databases and six general databases were evaluated. The best performer provided 75.9% of the answers for scope and scored 69.7% for completeness. Databases generally performed less effectively in providing answers sourced from clinical guidelines compared with more conservative sources such as package inserts. CONCLUSIONS: Overall, general medicines information CDSTs performed better than paediatric-specific CDSTs in both scope and completeness. Results from this study may help guide CDST selection on mobile devices by healthcare professionals whose patient populations include paediatrics.

Pharmacist use of social media.

INTRODUCTION: The rapid emergence and exploding usage of social media (also called Web 2.0) present pharmacists with new professional, ethical and time management challenges. OBJECTIVES: To describe social media use among pharmacists in West Virginia, USA. METHODS: A survey was administered during the West Virginia Pharmacist Association 102nd Annual Convention held in October 2009. The meeting participants were pharmacists practising in the different regions of West Virginia. All conference attendees were eligible to participate. RESULTS: The survey was completed by all 50 pharmacists in attendance, yielding a response rate of 100%. Social media use was found to be common among West Virginia pharmacists, with the most frequently used applications including: YouTube (74%), Wikipedia (72%), Facebook (50%), and blogs (26%). However, there were some tools that pharmacists barely used such as Bebo, Hi5, Flickr and Friendster. Given the widespread use of Facebook by respondent pharmacists, it is noteworthy that they indicated the main purposes for using it were for chatting, uploading pictures and keeping touch with friends rather than for professional and educational purposes. DISCUSSION: Presently, pharmacists utilize social media primarily for personal purposes. As social media becomes more sophisticated and widely adopted in the healthcare arena, it is probable that pharmacists will also increasingly utilize it for professional and educational purposes.

Pharmacy students' personal and professional use of social media.

INTRODUCTION: Current literature does not describe behaviors or the overarching opinion of pharmacy students on the use of different types of social media for personal and professional purposes. The objectives of this study were to identify predominant beliefs among pharmacy students regarding use of social media for professional and personal purposes, characterize pharmacy students' opinions on the effects of social media on their professional career, and determine pharmacy students' perceptions of using social media as tools for learning and discovery. METHODS: A self-administered questionnaire was administered to pharmacy students at Auburn University (N = 450) and Lipscomb University (N = 212). Linear regression was performed to predict students' perceptions of the importance of social media to their future professional life. RESULTS: The leading platforms commonly used by students for personal reasons were Facebook (92.5%), Instagram (70.5%), and Snapchat (70.5%). The most popular platforms used for professional reasons included LinkedIn (40.4%), Facebook (35.4%), and YouTube (29.2%). About 50% of respondents perceived social media to be important to their future professional life as pharmacists. Most students used YouTube and Wikipedia while studying or learning. The regression model predicting students' perceptions of the importance of social media to their future professional life was significant. CONCLUSIONS: Pharmacy students most commonly use Facebook, Instagram, and Snapchat for personal reasons, and LinkedIn, Facebook, and YouTube for professional reasons. Educators may leverage YouTube and wikis to support the education of pharmacy students. Pharmacy students appear to be more aware and active with security settings than previously reported.

Effects of commercial energy drink consumption on athletic performance and body composition.

Energy drinks are frequently marketed to individuals interested in athletics and an active lifestyle. From 2001 to 2008, estimates of energy drink use in adolescent to middle-aged populations ranged from 24% to 56%. Most energy drinks feature caffeine and a combination of other components, including taurine, sucrose, guarana, ginseng, niacin, pyridoxine, and cyanocobalamin. This article examines the evidence for 2 commonly purported uses of energy drinks: athletic performance enhancement and weight loss. Observed ergogenic benefits of energy drinks are likely attributable to caffeine and glucose content. There is conflicting evidence regarding the impact of energy drinks on weight loss, although some data suggest that combining energy drink use with exercise may enhance body fat reduction. As with any pharmacologically active substance, energy drinks are associated with adverse effects. Combining energy drinks with alcohol exacerbates safety concerns and is an increasingly common practice contributing to toxic jock identity among college-aged male athletes. Practitioners should monitor identified populations likely to consume these loosely regulated beverages.

The Florida Mobile Health Adherence Project for People Living With HIV (FL-mAPP): Longitudinal Assessment of Feasibility, Acceptability, and Clinical Outcomes.

BACKGROUND: For people living with HIV (PLWH), antiretroviral therapy (ART) adherence is crucial to attain better health outcomes. Although research has leveraged consumer health information technologies to enhance ART adherence, no study has evaluated feasibility and clinical outcomes associated with the usage of a commercially available, regularly updated mobile health (mHealth) app for improving ART adherence among PLWH. OBJECTIVE: This study aimed to assess the feasibility, acceptability, and clinical outcomes of Care4Today, an existing, free, biprogrammatic mHealth app for improving ART adherence among PLWH. METHODS: The Florida mHealth Application Adherence Project (FL-mAPP) was a 90-day longitudinal pilot study conducted in 3 public HIV clinics in Florida, United States. After obtaining informed consent, 132 participants completed a survey and then were given the option to try an existing mHealth app to help with ART adherence. Of these, 33.3% (44/132) declined, 31.1% (41/132) agreed but never used the app, and 35.6% (47/132) used the app. All were asked to complete follow-up surveys at 30 days and 90 days after enrollment. Usage data were used to assess feasibility. Clinical outcomes of self-reported ART adherence and chart-obtained HIV viral load and CD4+ T-cell counts were compared among those who used the platform (users) versus those who did not (nonusers). Participants and HIV care providers also provided responses to open-ended questions about what they liked and did not like about the app; comments were analyzed using thematic analysis. RESULTS: Of 132 participants, 47 (35.6%) and 85 (64.4%) were categorized as users and nonusers, respectively. Among users, a Kaplan-Meier plot showed that 25 persons (53%) continued using the app after the 90-day follow-up. At 30-day follow-up, 13 (81.3%) of those who used the mHealth app reported ≥95% ART adherence, compared with 17 (58.6%) nonusers (P=.12). Overall, 39 (82%) users liked or somewhat liked using the platform. Participants' favorite features were medication reminders, ability to create custom reminders, and adherence reports. CONCLUSIONS: This longitudinal study found that a commercially available medication adherence mHealth app was a feasible and acceptable intervention to improve ART adherence among PLWH and engaged in clinical care across 3 public HIV clinics in the state of Florida. Overall, participants liked the Care4Today app and thought the medication reminders were their favorite feature. Generally, self-reports of ART adherence were better among users than nonusers, both at 30- and 90-day follow-ups. Further clinical research needs to address user fatigue for improving app usage.

Physician attitudes toward pharmacist provision of medication therapy management services.

OBJECTIVE: The implementation of Medicare Part D in 2006 has the potential to advance the profession of pharmacy through the provision and remuneration of pharmacist-provided medication therapy management (MTM) services. Limited research has evaluated physician attitudes toward pharmacist-provided MTM services, and little is known about factors that may affect these attitudes. The aim of this study was to test a model of physicians' attitudes toward pharmacist-provided MTM services as a part of Medicare Part D. SETTING AND METHOD: A mail survey was sent to a random sample of 500 physicians practicing in West Virginia. Multiple linear regression was used to test the model. MAIN OUTCOME MEASURE: The independent variables included prescription volume, specialty type, years of practice, gender, academic affiliation, practice size, physicians' attitudes toward collaborative agreement, and physician-pharmacist communication frequency. Additionally, physician age was included as a control variable. RESULTS: A total of 102 responses were received yielding a response rate of 22.1%. The mean for physicians' attitude to support provision of MTM by pharmacists was 2.84 out of 5. The overall physicians' attitudes model for provision of MTM by pharmacists was found to be significant. Physicians' attitudes toward collaborative agreement, specialty, years of practice, physician-pharmacist communication frequency regarding patients communication, and gender had significant influences on physician attitudes toward provision of MTM by pharmacists. CONCLUSION: The proposed model can provide insight into physicians' attitudes toward provision of MTM by pharmacists and may be helpful in developing future approaches and policies to further improve this collaborative relationship.

Nurse prescribers' interactions with and perceptions of pharmaceutical sales representatives.

AIMS AND OBJECTIVES: The aim of our study was to investigate the perceptions of pharmaceutical sales representatives by nurse prescribers. BACKGROUND: Nurses with advanced training have earned prescriptive authority in North America, Europe and other parts of the world. These nurses are being increasingly targeted by pharmaceutical sales representatives. There is a paucity of data regarding nurses' perceptions of pharmaceutical sales representatives. DESIGN: Survey. METHODS: A convenience sample of nurse prescribers was recruited to complete an Internet questionnaire about their interactions with and perceptions of sales representatives. The data were collected over one month ending in January 2007. There were 39 survey items ranging from perception-based items assessed by Likert-type scale to open-ended queries. Descriptive statistics were used to summarise the results. RESULTS: Ninety-two nurses completed this survey, which demonstrated good internal consistency yielding a Cronbach's alpha coefficient of 0.83. Positive perceptions of pharmaceutical representatives included: explaining their products clearly (80.4%) and knowledge about their medications (88.0%). Negative aspects included: lack of consideration of nurses' time (50%) and failure to equally discuss medication strengths and weaknesses (21.8%). Perhaps the most alarming finding was that 35.9% of respondents indicated that sales representatives suggested paybacks for promoting their drugs. CONCLUSIONS: Nurses with prescriptive authority generally perceive interactions with pharmaceutical sales representatives as positive. However, they also have concerns about the nature and methods of some of their activities. Nations that have nurses with prescribing authority can benefit from observing both the mis-steps and the positive inroads that have already been made by the profession in the USA and other countries. RELEVANCE TO CLINICAL PRACTICE: Appropriate use of pharmaceutical sales representatives' services may enhance the ability of nurse prescribers to deliver optimal nursing care. Methods, such as counter-detailing may be necessary to maintain an evidence-based approach as the controlling factor.

Characteristics of physicians who frequently see pharmaceutical sales representatives.

Pharmaceutical sales representatives (PSRs) can impact physician prescribing. The objective of this study was to test a model of physician and practice setting characteristics as influences on decisions by physicians to see PSRs. A survey was sent to a random sample of 2000 physicians. Multiple linear regression analyses were used to test models for predicting influences on decisions to see PSRs frequently, defined as at least monthly. Independent variables included: presence of restrictive policy for pharmaceutical detailing, volume of prescriptions, gender, age, type of specialty, academic affiliation, practice setting size, and urban versus rural. The dependent variable was frequency of PSRs visits to physicians. Six hundred seventy-one responses were received yielding a response rate of 34.7%. Four hundred thirty-two physicians (79.5%) reported seeing PSRs at least monthly. The decision influence model was found to be significant. Primary care physicians and high-volume prescribers showed increased likelihood to see PSRs. Physicians practicing in settings that were small, urban, without restrictive policies for pharmaceutical detailing, and not academically affiliated were more likely to see PSRs frequently. This model of physician and practice characteristics is useful in explaining the variations in physicians' characteristics who see PSRs frequently. These characteristics could be used to guide the development of future academic or counter-detailing initiatives to improve evidence-based prescribing.

Updating the Model: The Case for Independent Pharmacy to Embrace Digital Health.

OBJECTIVES: To advocate for independent pharmacy to embrace digital health as a means to improve patient outcomes and compete more strongly in an increasingly competitive business environment. SUMMARY: Independent pharmacies are positioned to be at the forefront of adopting digital health tools for a variety of reasons. They often can make changes to their business model faster than a major retail chain, are often in rural locations where few other providers are located, and are already starting to offer the types of clinical services that can be greatly aided by digital health. This commentary presents the case for a change in the current model of pharmacy practice to one which embraces digital health. The role of the pharmacist would grow beyond exclusively medication management to incorporate tools such as wearable health trackers and mobile phone applications. By utilizing digital health, the pharmacist can obtain a greater amount of patient health data via an asynchronous electronic uploading process, and then use that data to further improve their ability to offer clinical services. CONCLUSION: Digital health is a powerful tool that should be embraced by independent pharmacy. By leveraging digital health, pharmacies can improve both accessibility and quality of care, thus providing a competitive advantage in the retail marketplace.

Ability of online drug databases to assist in clinical decision-making with infectious disease therapies.

BACKGROUND: Infectious disease (ID) is a dynamic field with new guidelines being adopted at a rapid rate. Clinical decision support tools (CDSTs) have proven beneficial in selecting treatment options to improve outcomes. However, there is a dearth of information on the abilities of CDSTs, such as drug information databases. This study evaluated online drug information databases when answering infectious disease-specific queries. METHODS: Eight subscription drug information databases: American Hospital Formulary Service Drug Information (AHFS), Clinical Pharmacology (CP), Epocrates Online Premium (EOP), Facts & Comparisons 4.0 Online (FC), Lexi-Comp (LC), Lexi-Comp with AHFS (LC-AHFS), Micromedex (MM), and PEPID PDC (PPDC) and six freely accessible: DailyMed (DM), DIOne (DIO), Epocrates Online Free (EOF), Internet Drug Index (IDI), Johns Hopkins ABX Guide (JHAG), and Medscape Drug Reference (MDR) were evaluated for their scope (presence of an answer) and completeness (on a 3-point scale) in answering 147 infectious disease-specific questions. Questions were divided among five classifications: antibacterial, antiviral, antifungal, antiparasitic, and vaccination/immunization. Classifications were further divided into categories (e.g., dosage, administration, emerging resistance, synergy, and spectrum of activity). Databases were ranked based on scope and completeness scores. ANOVA and Chi-square were used to determine differences between individual databases and between subscription and free databases. RESULTS: Scope scores revealed three discrete tiers of database performance: Tier 1 (82-77%), Tier 2 (73-65%) and Tier 3 (56-41%) which were significantly different from each other (p < 0.05). The top tier performers: MM (82%), MDR (81%), LC-AHFS (81%), AHFS (78%), and CP (77%) answered significantly more questions compared to other databases (p < 0.05). Top databases for completeness were: MM (97%), DM (96%), IDI (95%), and MDR (95%). Subscription databases performed better than free databases in all categories (p = 0.03). Databases suffered from 37 erroneous answers for an overall error rate of 1.8%. CONCLUSION: Drug information databases used in ID practice as CDSTs can be valuable resources. MM, MDR, LC-AHFS, AHFS, and CP were shown to be superior in their scope and completeness of information, and MM, AHFS, and MDR provided no erroneous answers. There is room for improvement in all evaluated databases.

Scope, completeness, and accuracy of drug information in Wikipedia.

BACKGROUND: With the advent of Web 2.0 technologies, user-edited online resources such as Wikipedia are increasingly tapped for information. However, there is little research on the quality of health information found in Wikipedia. OBJECTIVE: To compare the scope, completeness, and accuracy of drug information in Wikipedia with that of a free, online, traditionally edited database (Medscape Drug Reference [MDR]). METHODS: Wikipedia and MDR were assessed on 8 categories of drug information. Questions were constructed and answers were verified with authoritative resources. Wikipedia and MDR were evaluated according to scope (breadth of coverage) and completeness. Accuracy was tracked by factual errors and errors of omission. Descriptive statistics were used to summarize the components. Fisher's exact test was used to compare scope and paired Student's t-test was used to compare current results in Wikipedia with entries 90 days prior to the current access. RESULTS: Wikipedia was able to answer significantly fewer drug information questions (40.0%) compared with MDR (82.5%; p < 0.001). Wikipedia performed poorly regarding information on dosing, with a score of 0% versus the MDR score of 90.0%. Answers found in Wikipedia were 76.0% complete, while MDR provided answers that were 95.5% complete; overall, Wikipedia answers were less complete than those in Medscape (p < 0.001). No factual errors were found in Wikipedia, whereas 4 answers in Medscape conflicted with the answer key; errors of omission were higher in Wikipedia (n = 48) than in MDR (n = 14). There was a marked improvement in Wikipedia over time, as current entries were superior to those 90 days prior (p = 0.024). CONCLUSIONS: Wikipedia has a more narrow scope, is less complete, and has more errors of omission than the comparator database. Wikipedia may be a useful point of engagement for consumers, but is not authoritative and should only be a supplemental source of drug information.

Clinical decision support tools: personal digital assistant versus online dietary supplement databases.

BACKGROUND: Clinical decision support tools (CDSTs) on personal digital assistants (PDAs) and online databases assist healthcare practitioners who make decisions about dietary supplements. OBJECTIVE: To assess and compare the content of PDA dietary supplement databases and their online counterparts used as CDSTs. METHODS: A total of 102 question-and-answer pairs were developed within 10 weighted categories of the most clinically relevant aspects of dietary supplement therapy. PDA versions of AltMedDex, Lexi-Natural, Natural Medicines Comprehensive Database, and Natural Standard and their online counterparts were assessed by scope (percent of correct answers present), completeness (3-point scale), ease of use, and a composite score integrating all 3 criteria. Descriptive statistics and inferential statistics, including a chi(2) test, Scheffé's multiple comparison test, McNemar's test, and the Wilcoxon signed rank test were used to analyze data. RESULTS: The scope scores for PDA databases were: Natural Medicines Comprehensive Database 84.3%, Natural Standard 58.8%, Lexi-Natural 50.0%, and AltMedDex 36.3%, with Natural Medicines Comprehensive Database statistically superior (p < 0.01). Completeness scores were: Natural Medicines Comprehensive Database 78.4%, Natural Standard 51.0%, Lexi-Natural 43.5%, and AltMedDex 29.7%. Lexi-Natural was superior in ease of use (p < 0.01). Composite scores for PDA databases were: Natural Medicines Comprehensive Database 79.3, Natural Standard 53.0, Lexi-Natural 48.0, and AltMedDex 32.5, with Natural Medicines Comprehensive Database superior (p < 0.01). There was no difference between the scope for PDA and online database pairs with Lexi-Natural (50.0% and 53.9%, respectively) or Natural Medicines Comprehensive Database (84.3% and 84.3%, respectively) (p > 0.05), whereas differences existed for AltMedDex (36.3% vs 74.5%, respectively) and Natural Standard (58.8% vs 80.4%, respectively) (p < 0.01). For composite scores, AltMedDex and Natural Standard online were better than their PDA counterparts (p < 0.01). CONCLUSIONS: Natural Medicines Comprehensive Database achieved significantly higher scope, completeness, and composite scores compared with other dietary supplement PDA CDSTs in this study. There was no difference between the PDA and online databases for Lexi-Natural and Natural Medicines Comprehensive Database, whereas online versions of AltMedDex and Natural Standard were significantly better than their PDA counterparts.